| NPI | 1396256251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AZ 4907) |
| Additional Taxonomies | 103TA0700X Psychologist Adult Development & Aging (Licence: AZ 4907) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: AZ 4907) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: AZ 4907) | |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2017-11-14 |